scholarly journals Arterial hypertension as a trigger for the development of cardiorenal failure in patients of different genders

2019 ◽  
Vol 34 (3) ◽  
pp. 114-121
Author(s):  
E. A. Lopina ◽  
N. P. Grishina ◽  
R. A. Libis
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Arterial Hypertension ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Aim. To study the peculiarities of changes in the functional state of the kidneys and heart muscle in patients with arterial hypertension.Materials and Methods. A total of 88 patients with arterial hypertension were included in the study. Chronic kidney disease was detected based on glomerular filtration rate, albuminuria, and cystatin levels in serum and urine. The stage of chronic heart failure was determined according to Strazhesko–Vasilenko classification with functional class according to NYHA; functional class of chronic heart failure was determined based on six-minute walking test. Patient inclusion criteria were the presence of essential hypertension of degree 1–3 and the age from 50 to 70 years. Patients underwent anthropometry, biochemical blood tests, six-minute walking test, and standard echocardiography.Results. Arterial hypertension of degree 1–2 was diagnosed in 50 patients including 33 women and 17 men. Grade 3 arterial hypertension was found in 38 patients (28 women and 10 men). Patients were divided into two groups according to gender. The groups with arterial hypertension degree 1–2 differed in their blood pressure levels. Echocardiography data showed the formation of heart failure with preserved ejection fraction. The groups differed in the values of left ventricular ejection fraction and end-systolic and end-diastolic sizes of the left ventricle. The levels of cystatin C in serum were elevated in both groups. The serum and urine creatinine levels and glomerular filtration rates differed between groups. Women had more significant decreases in the values of glomerular filtration rate, cystatin C, and urine creatinine. Correlation relationships were found between systolic blood pressure and glomerular filtration rate (r = 0.27, p < 0.05) and between systolic blood pressure and left ventricular back wall thickness (r = 0.41, p < 0.05). Inverse relationship was found between left ventricular ejection fraction and albuminuria (r = –0.31, p < 0.05). Cystatin C level had inverse relationship with glomerular filtration rate (r = –0.47, p < 0.05) and direct relationship with left ventricular myocardial mass index (r =  0.24, p  <  0.05).Discussion. Chronic kidney disease and chronic heart failure with preserved left ventricular ejection fraction were detected in patients at early stages. In the group of women, more pronounced changes in the renal and cardiac functions were found. Cystatin C is a marker of kidney function reduction and an alternative marker of chronic heart failure. The study showed that the level of cystatin C in blood serum of patients was increased, which correlated with the functional activities of the kidneys and the heart.Conclusion. In case of arterial hypertension in the presence of chronic kidney disease, the development of the left ventricular hypertrophy and heart failure with preserved ejection fraction was found. Women had more significant changes in the renal and cardiac functions compared with those in men. 

Сhanges in the functional state of the epithelium of the proximal renal tubules in patients with the initial stage of chronic heart failure during simvastatin therapy

2020 ◽  
Vol 65 (10) ◽  
pp. 602-606
Author(s):  
V. Yu. Kopylov
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Heart Failure ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Comparison Group ◽  
Control Group ◽  
Simvastatin Therapy ◽  
Initial Stage

To assess the change in the functional state of the proximal renal tubule epithelium in patients with dyslipidemia on the background of obesity, by determining the concentration in the urine of the examined level of cystatin C and the degree of activity of the renal organ-specific enzymes neutral α-glucosidase (NAG) and L-alaninaminopeptidase (laap) during simvastatin therapy at a daily dose of 20 mg for 6 months. The study involved 88 people who were divided into three groups: control, comparison and main. The control group is a group of practically healthy individuals: 30 people, average age 20.67 ± 0.18 years, body mass index (BMI) 21.36 ± 0.4 kg/m2. Comparison group (obese): 27 people, average age 22.38 ± 0.76 years, BMI 31.48 ± 0.56 kg / m2. Patients of the main group were divided into 2 subgroups. The first main subgroup of persons with chronic heart failure stage I (CHF I) without type 2 diabetes mellitus (DM 2)) - 15 observed: average age 56.8 ± 1.8 years, BMI 30.28 ± 1.11 kg / m2. The second main subgroup (CHF I with DM 2) - 16 observed: average age 48.25 ± 2.45 years, BMI 30.37 ± 1.11 kg/m2. The study found that simvastatin therapy does not affect glomerular filtration rate in patients with asymptomatic heart dysfunction. There was an increased level of cystatin C in the urine of the comparison group compared to the control group, the concentration of cystatin C in the main subgroups was statistically significantly higher than the control group. On the background of simvastatin therapy for 6 months, the level of this analyte is statistically significantly increased. The activity of LAAP and NAG during simvastatin therapy during the follow-up period in the CHF I subgroup without DM2 significantly decreased. In the subgroup of CHF I + DM2, a decrease in the concentration of LAAP and an increase in the activity of NAG was revealed, which may indicate that the brush border epithelium dystrophy occurred during simvastatin therapy. Simvastatin therapy for 6 months in patients with the initial stage of heart failure at a daily dosage of 20 mg does not impair glomerular function in the form of reduced glomerular filtration rate (GFR). Cystatin C levels are higher in obese individuals without heart failure and significantly higher in those with asymptomatic heart failure. When treating dyslipidemia with simvastatin at a dose of 20 mg / day, there is a decrease in the activity of NAG and laap in patients with CHF I without DM2. In the result of lipid-lowering therapy with simvastatin in a daily dosage of 20 mg in patients with CHF I+D2M there is increased activity of NAG while reducing the concentration of the LAAP, which may be due to degeneration of the proximal tubular epithelium, amid additional load on a partially renal route of metabolism of simvastatin.

scholarly journals The Discriminatory Ability of Renalase and Biomarkers of Cardiac Remodeling for the Prediction of Ischemia in Chronic Heart Failure Patients With the Regard to the Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Dijana Stojanovic ◽  
Valentina Mitic ◽  
Miodrag Stojanovic ◽  
Dejan Petrovic ◽  
Aleksandra Ignjatovic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Cystatin C ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Discriminatory Ability ◽  
Galectin 3

Background: Renalase has been implicated in chronic heart failure (CHF); however, nothing is known about renalase discriminatory ability and prognostic evaluation. The aims of the study were to assess whether plasma renalase may be validated as a predictor of ischemia in CHF patients stratified to the left ventricular ejection fraction (LVEF) and to determine its discriminatory ability coupled with biomarkers representing a range of heart failure (HF) pathophysiology: brain natriuretic peptide (BNP), soluble suppressor of tumorigenicity (sST2), galectin-3, growth differentiation factor 15 (GDF-15), syndecan-1, and cystatin C.Methods: A total of 77 CHF patients were stratified according to the LVEF and were subjected to exercise stress testing. Receiver operating characteristic curves were constructed, and the areas under curves (AUC) were determined, whereas the calibration was evaluated using the Hosmer-Lemeshow statistic. A DeLong test was performed to compare the AUCs of biomarkers.Results: Independent predictors for ischemia in the total HF cohort were increased plasma concentrations: BNP (p = 0.008), renalase (p = 0.012), sST2 (p = 0.020), galectin-3 (p = 0.018), GDF-15 (p = 0.034), and syndecan-1 (p = 0.024), whereas after adjustments, only BNP (p = 0.010) demonstrated predictive power. In patients with LVEF &lt;45% (HFrEF), independent predictors of ischemia were BNP (p = 0.001), renalase (p &lt; 0.001), sST2 (p = 0.004), galectin-3 (p = 0.003), GDF-15 (p = 0.001), and syndecan-1 (p &lt; 0.001). The AUC of BNP (0.837) was statistically higher compared to those of sST2 (DeLong test: p = 0.042), syndecan-1 (DeLong: p = 0.022), and cystatin C (DeLong: p = 0.022). The AUCs of renalase (0.753), galectin-3 (0.726), and GDF-15 (0.735) were similar and were non-inferior compared to BNP, regarding ischemia prediction. In HFrEF patients, the AUC of BNP (0.980) was statistically higher compared to those of renalase (DeLong: p &lt; 0.001), sST2 (DeLong: p &lt; 0.004), galectin-3 (DeLong: p &lt; 0.001), GDF-15 (DeLong: p = 0.001), syndecan-1 (DeLong: p = 0.009), and cystatin C (DeLong: p = 0.001). The AUC of renalase (0.814) was statistically higher compared to those of galectin-3 (DeLong: p = 0.014) and GDF-15 (DeLong: p = 0.046) and similar to that of sST2. No significant results were obtained in the patients with LVEF &gt;45%.Conclusion: Plasma renalase concentration provided significant discrimination for the prediction of ischemia in patients with CHF and appeared to have similar discriminatory potential to that of BNP. Although further confirmatory studies are warranted, renalase seems to be a relevant biomarker for ischemia prediction, implying its potential contribution to ischemia-risk stratification.

scholarly journals Heart remodeling in elderly patients with isolated systolic arterial hypertension and chronic heart failure with preserved left ventricular ejection fraction

2021 ◽  
Vol 23 (3) ◽  
pp. 331-337
Author(s):  
S. O. Sheiko ◽  
N. O. Kolb
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Arterial Hypertension ◽  
Comparison Group ◽  
Left Ventricular ◽  
Main Group ◽  
Volume Index ◽  
Left Ventricular Ejection

The aim of the work was to study the structural and functional state of the left ventricle (LV) in elderly patients with isolated systolic arterial hypertension (ISAH) and chronic heart failure with preserved ejection fraction (CHF with PEF). Materials and methods. After receiving an informed consent, 134 elderly patients with ISAH were enrolled in the study. The main group included 91 patients aged 71.1 ± 3.5 years with ISAH and ejection fraction (EF) of the LV >50 % and a level of natriuretic peptide (NT-proBNP) >125 pg/ml. Among them, there were 61 women (67 %) and 30 (33 %) men. The comparison group consisted of 43 patients (27 women and 16 men aged 70.4 ± 3.7 years) with ISAH, LV EF >50% and NT-proBNP <125 pg/ml. The geometric changes of the LV were evaluated taking into account the LV myocardial mass index and the relative LV wall thickness. Results. Cardiac remodeling in elderly ISAH patients with CHF and PEF was represented by the following geometric variants of the LV. In the main group patients, concentric LV hypertrophy (LVH) prevailed – 73 (80.2 %) patients, while in the comparison group, concentric modeling (CR) – 25 (58.1 %) patients (P < 0.01 by criterion χ2). CR in the ISAH patients with CHF and PEF was diagnosed in 18 (19.8 %) cases. Concentric LVH was verified in 18 (41.9 %) patients of the comparison group (P < 0.01). It was determined that the hyperfunction of the left atrium (LA) in the patients with ISAH without CHF was compensatory. The maximum volume index of the LA (VILAmax.) in these patients was in the range of 27–32 ml/m2. Hyperfunction of the LA in the ISAH patients with CHF and PEF was accompanied by a statistically significant increase in VILAmax. over 34 ml/m2. Conclusions. The prevalence of ISAH among elderly patients is 35.6 %. The formation of a hypertensive heart in the ISAH patients with CHF and PEF is characterized by a predominant concentric LVH (80.2 %) and hyperfunction of the LA. A significant increase in the LA volumes testifies to increase in its contribution to the LV filling with the formation of LV diastolic dysfunction. The presence of concentric LVH and an increase in VILAmax. ≥34 ml/m2 is a criterion for identifying individuals at high and very high risk among elderly ISAH patients with CHF and PEF.

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